How to Read a Paper describes the different types of clinical research reporting, and explains how to critically appraise the publications. The book provides the tools to find and evaluate the literature, and implement the findings in an evidence-based, patient-centered way. Written for anyone in the health care professions who has little or no knowledge of evidence-based medicine, it provides a clear understanding of the concepts and how to put them into practice at the basic, clinical level.

Changes for the 4th edition

The fourth edition will include two new chapters on important developments in health care research and delivery, but otherwise retains its original style, size, and scope.

* New chapter on quality improvement - describing papers on quality improvement projects using ebm methods; this will extend the readership to non clinical health care professionals working in hospitals and family practice, and to nurse specialists and practice nurses working in this field
* New chapter on complex interventions - how to set up research projects involving both qualitative and quantitative methodology (known as mixed methods)
* Thorough revision and updating of existing chapters and references
* New illustrations - diagrammatic representations of ebm concepts

Foreword to the first edition by Professor Sir David Weatherall

1. Why read papers at all?

1.1 Does ‘evidence-based medicine’ simply mean ‘reading papers in medical journals’?
1.2 Why do people often groan when you mention evidence-based medicine?
1.3 Before you start: formulate the problem

2. Searching the literature

2.1 Searching for evidence: key principles
2.2 Medline and other ‘raw’ databases
2.3 Databases with search filters
2.4 Databases of pre-appraised articles
2.5 Databases of synthesised evidence
2.6 Databases of ongoing research
2.7 Citation searching
2.8 Human contact sources
2.9 Worked examples of search problems

3. Getting your bearings: what is this paper about?

3.1 The science of ‘trashing’ papers
3.2 Three preliminary questions to get your bearings
3.3 Randomised controlled trials
3.4 Cohort studies
3.5 Case-control studies
3.6 Cross-sectional surveys
3.7 Case reports
3.8 The traditional hierarchy of evidence
3.9 A note on ethics and governance

4. Assessing methodological quality

4.1 Was the study original?
4.2 Who is the study about?
4.3 Was the design of the study sensible?
4.4 Was systematic bias avoided or minimised?
4.5 Was assessment 'blind'?
4.6 Were preliminary statistical questions addressed?

5. Statistics for the non-statistician

5.1 How can non-statisticians evaluate statistical tests?
5.2 Have the authors set the scene correctly?
5.3 Paired data, tails, and outliers
5.4 Correlation and causation
5.5 Probability and confidence
5.6 The bottom line (quantifying the risk of benefit and harm)

6. Papers that report trials of drug treatments and other simple interventions?

6.1 ‘Evidence’ and marketing
6.2 Making decisions about therapy
6.3 Surrogate endpoints
6.4 What information to expect in a paper describing a randomised controlled trial
6.5 Getting worthwhile evidence from pharmaceutical representatives

7. Papers that report trials of complex interventions

7.1 ‘Evidence’ and marketing
7.2 Making decisions about therapy
7.3 Surrogate endpoints
7.4 Getting worthwhile evidence from pharmaceutical representatives

8. Papers that report diagnostic or screening tests

8.1 Ten men in the dock
8.2 Validating diagnostic tests against a gold standard
8.3 Ten questions to ask about a paper which claims to validate a diagnostic or screening test
8.4 A note on likelihood ratios

9. Papers that summarise other papers (systematic reviews and meta-analyses)

9.1 When is a review systematic?
9.2 Evaluating systematic reviews
9.3 Meta-analysis for the non-statistician
9.4 Explaining heterogeneity

10. Papers that tell you what to do (guidelines)

10.1 The great guidelines debate
10.2 Do guidelines change clinicians’ behaviour?
10.3 Ten questions to ask about a clinical guideline

11. Papers that tell you what things cost (economic analyses)

11.1 What is an economic evaluation?
11.2 Measuring the costs and benefits of health interventions
11.3 Ten questions to ask about an economic evaluation

12. Papers that go beyond numbers (qualitative research)

12.1 What is qualitative research?
12.2 Evaluating papers that describe qualitative research

13. Papers that report questionnaire research

13.1 The rise and rise of questionnaire research
13.2 Ten questions to ask about a paper describing questionnaire research

14 Papers that report quality improvement case studies

14.1 What is quality improvement - and how should we research it?
14.2 Ten questions to ask about a paper describing a quality improvement initiative

15. Getting evidence into practice

15.1 Why are health professionals slow to adopt evidence-based practice?

15.2 How much avoidable suffering is caused by failure to implement evidence?
15.3 How can we influence health professionals' behaviour to promote evidence-based practice?
15.4 What does an ‘evidence-based organisation’ look like?
15.5 How can we help organisations develop the appropriate structures, systems and values to support evidence-based practice?
15.6 How can we get evidence into policymaking?

Appendix 1 Checklists for finding, appraising and implementing evidence

Appendix 2 Assessing the effects of an intervention